The review shows the Department of Health and Human Services did not comply with federal requirements to report and monitor incidents involving abuse or deaths of disabled people in the care of community-based providers.

Kim Humphrey and her son Daniel Humphrey pose on the trampoline that Daniel loves in the backyard of the group home in Lewiston where he lives. Daniel, 28, has severe autism and is nonverbal. He needs round-the-clock care and has lived in John F. Murphy homes since 2009. His mother said it has been nothing but a positive experience, so when she heard about mistreatment of developmentally disabled patients in Maine, she was horrified. Humphrey said the thought of someone mistreating someone as vulnerable as her son keeps her awake at night. Staff photo by Brianna Soukup

During a 2 1/2-year period ending in June 2015, the DHHS didn’t investigate 133 deaths and didn’t report 34% of the critical incidents involving developmentally challenged Medicaid patients.

The review of medical records and incident reports from January 2013 to June 2015 indicates that the Maine Department of Health and Human Services did not comply with requirements for reporting and monitoring critical incidents for the 2,640 Medicaid beneficiaries being cared for by community-based providers during that time. Included in that population are about 1,800 adults with intellectual disabilities who live in group homes, according to the Maine Association for Community Service Providers.

For Kim Humphrey, 61, of Auburn, the report is “alarming” even though she said her “severely autistic” son has not suffered from any abuse at the group home where he’s been living since 2009.

“It’s awful that (Maine DHHS) is not being accountable for things that are harming people,” Humphrey said. “It’s really terrifying.”

Humphrey said her son, Daniel, is nonverbal so if he were in an abusive situation, he would be vulnerable to assaults or neglect. The idea that cases of abuse would not be reported to authorities and could be kept quiet is unsettling, she said.

“You would have situations where agencies are investigating themselves,” Humphrey said. “You want to have outside eyes looking at it.”

The people being cared for have intellectual and mental health disabilities, such as autism or very low intelligence, and can’t care for themselves. The community-based providers range from licensed group homes with professional caretakers to family members caring for a relative in a personal home.

The audit by the Office of the Inspector General was narrowly focused on reporting and monitoring critical incidents, which include medication issues, such as a patient refusing medication or a provider making a medication error; abuse and neglect; injuries and exploitation.

One death that was not investigated involved a woman who drowned while unattended in a bathtub, investigators said.

DHHS: ‘TRANSITION’ AFFECTED AUDIT PERIOD

In a statement Thursday, DHHS said the report is accurate for the period it covers, but doesn’t reflect current practices. The audit period includes a time of “significant transition” after DHHS reorganized to incorporate two other departments and create the Office of Aging and Disability, which oversees developmentally disabled Medicaid patients in Maine.

“The department recognizes that issues identified by OIG did exist during this transitional phase, many of which were discovered prior to the time of this audit and have been addressed by the department,” the statement said. “We are proud that we have successfully made improvements since the audit period.

DHHS did not include any data with its statement that would show how the system has improved, and it would not respond to any follow-up questions from reporters.

On Thursday, former DHHS Commissioner Mary Mayhew issued a statement saying the audit “is a reflection of prior administrations and years of explosive entitlement growth prioritizing able-bodied adults at the expense of our most vulnerable.”

Mayhew, who is running for governor, was DHHS commissioner from 2011 to May of this year.

“There is nothing more important than the health and well being of our most vulnerable citizens. That’s why I fought for and prioritized $100 million extra for our disabled adults while I was at DHHS,” she said. “Today the department is prioritizing our most vulnerable, there is financial discipline and stability, and a commitment to accountability and quality results.”

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Maine and other states that receive federal waivers to place Medicaid patients with home and community-based providers must have a reporting system to protect the health and welfare of beneficiaries, according to the Department of Health and Human Services.

Under the waiver, community-based providers must immediately enter any critical incidents such as abuse, medication issues and death into a database maintained by DHHS.

To verify whether these critical incidents were being properly reported, the auditors compared the database information to 2,243 critical incidents that led to hospital claims paid by the state for Medicaid beneficiaries with developmental disabilities.

They found that more than one-third of critical incidents were not reported.

The audit, conducted by the U.S. Department of Health and Human Services Office of the Inspector General, was part of a series of reviews in several states that focused on the reporting and monitoring of deaths and abuse of residents with developmental disabilities being cared for by community-based providers.

“There’s no one more vulnerable. They are at risk and it’s sad,” said David Lamir, the regional inspector general who oversaw the four-person, one-year Maine audit. Audits in Connecticut and Massachusetts found similar reporting problems, Lamir said. The Office of the Inspector General is expanding the audits to states across the nation.

SYSTEM TO REPORT INCIDENTS ‘IN DISARRAY’

Todd Goodwin, president of the Maine Association for Community Service Providers, which represents the nonprofit agencies that operate the group homes where the developmentally disabled live, said the system of reporting incidents is “in disarray.” He said Maine DHHS has not provided “clear guidance” to the nonprofits on the reporting requirements. Goodwin said as a result some nonprofits may faithfully report all incidents, while others may not.

“This is a good wake-up call,” Goodwin said. “This report, at the end of the day, is a good thing. We know there are flaws in the system, so let’s fix it and be part of the solution.”

Goodwin said DHHS has decreased the reimbursement rates it pays to the nonprofits that operate the group homes, causing a workforce crisis because the agencies can’t afford to pay much more than minimum wage to frontline workers who provide the direct care to the patients. The rates were improved during the budget negotiations that ended in July, but the new rates don’t take effect until October.

For the past few years, there’s been a constant churn of employees, and some group homes had to close because of a lack of workers, he said.

Goodwin said the workforce crisis caused by DHHS’ low reimbursement rates has affected the quality of care at the group homes.

“The staffing crisis puts great burdens on organizations,” Goodwin said. “One could imagine it would have an impact.”

The department did not investigate any of the 133 beneficiary deaths during the 30-month audit period, according to the report. Law enforcement did not open investigations into any of those deaths and the audit found no evidence was provided to a committee tasked with identifying potential trends. The audit found that nine of the deaths were unexplained, suspicious or untimely. There was not enough information about another 32 deaths to determine whether they were unexplained, suspicious or untimely.

In another section, the audit found that the state didn’t investigate all allegations of abuse, neglect or exploitation in a uniform way and within 30 days of the incident – and did not report all of those cases immediately to the appropriate district attorney’s office or law enforcement, as required. Auditors met with DHHS staff to discuss the outcome of 296 specific incidents involving sexual abuse or sexual exploitation.

Of those incidents, auditors found evidence that only five were referred to the appropriate district attorney’s office, and that DHHS did not maintain a list of incidents that were referred to a district attorney’s office.

“(DHHS) did not provide a complete explanation of why it did not investigate all allegations of abuse, neglect, or exploitation, or immediately report such critical incidents to the appropriate district attorney’s office,” the report said. “Various (DHHS) officials indicated that these problems occurred in part because the (DHHS) reorganized, the wording of the (federal) waiver needed to be revised, DHHS generally did not investigate resident-on-resident incidents, and it did not believe medication management errors always met the definition of neglect.”

WHAT’S NEXT FOR AUDITOR’S REPORT?

The Department of Health and Human Services told the federal inspector general’s office that the Mortality Review Committee reviewed 54 of the 133 beneficiary deaths, but the federal agency claims documentation provided by the state did not detail what the reviews entailed or the outcome, including potential corrective action. The state medical examiner’s office reviewed 13 of the 133 beneficiary deaths, but did not receive referrals from or share the results of the reviews with Maine DHHS.

State officials were unable to provide an explanation Thursday as to why Maine DHHS wasn’t ensuring providers reported all critical incidents.

In its statement, Maine DHHS said the audit “narrowly focused on a subset of data.”

“It is unfortunate that this OIG audit focuses on a small fraction of selective data and fails to evaluate the bigger picture of care and services,” the department said. “The department expressed to OIG that this is a complex system with many programs working together to assist and protect a vulnerable population and that the OIG’s approach did not capture all of the necessary data.”

According to the report, Maine officials agreed or partially agreed with all seven recommendations and with four of the six Health and Human Services findings. The state disagreed that it did not ensure that community-based providers reported all critical incidents and that it did not investigate or report critical incidents to the appropriate authorities.

The auditor’s report, which does not indicate any possible ramifications of the findings, will be reviewed by the Centers for Medicare and Medicaid Services, the federal agency that administers the Medicare program, OIG officials said.

Lydia Paquette, executive director of the Maine Association for Community Service Providers, said in a statement that her organization long has recognized the “deficiencies” in the system, and has recommended to Maine DHHS that a working group be established to examine the problem.

Paquette said the work group should “systematically review rules, policies and practices that impact individuals with intellectual and developmental disabilities as it relates to abuse, neglect and exploitation. To our knowledge, no such work group has been invited or convened.”

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